Pediatric emergency medicine trisk 2089 2089
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The initial evaluation of a patient with abnormal liver biochemical and
function tests (LFTs) includes obtaining a history to identify potential risk
factors for liver disease and performing a physical examination to look for
clues to the etiology and for signs of chronic liver disease. Subsequent testing
is determined based on the information gathered from the history and physical
examination as well as the pattern of LFT abnormalities. The goal of
emergency care is to determine if the patient is at risk for fulminant liver
failure.
CLINICAL PEARLS AND PITFALLS
A high index of suspicion is required to detect patients with viral
hepatitis as the aminotransferase elevation may be very mild in
children.
A history of immigration or adoption from high prevalence countries
or family/personal history of high-risk exposures should prompt
screening for hepatitis B virus (HBV) and hepatitis C virus (HCV),
even if liver transaminases are only mildly elevated.
Hepatitis A virus (HAV) IgM suggests current or recent hepatitis A
infection in the setting of HAV total antibody positivity. Treatment is
supportive.
HBV is 100-fold more infectious than human immunodeficiency virus
(HIV). A positive anti-HBs (surface antibody) is present. All HBsAgand HBcAb-positive patients merit confirmatory HBV DNA.
Infants at risk for vertical HCV transmission should not be tested
until 18 months of age as maternal HCV antibody can circulate for
over 1 year. If positive, confirm with HCV ribonucleic acid (RNA)
quantitative polymerase chain reaction (PCR) and refer to
Hepatology.
Current Evidence
The existing alphabet of hepatitis viruses is now up to G, excluding F, with
new variants awaiting discovery. HAV, the cause of “infectious” or epidemic
hepatitis, is an RNA virus transmitted by the fecal–oral route. Hepatitis A is
the second most common vaccine preventable infection in travelers and has an
incubation period of 28 days (range 15 to 50). Peak infectivity occurs during
